The Palomo procedure in the treatment of boys with varicocele: a retrospective study of testicular growth and fertility

The Palomo procedure has often been criticized with regard to possible atro phy of the testis. Measuring the testicular volume is mainly used in pre- a nd postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had a ny disturbance of their testicular growth and/or fertility. Out of 79 patie nts operated upon with Palomo's procedure between 1979 and 1990, 33 could b e evaluated. They all had grade If or III left-sided varicoceles. Investiga tions consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6-17 years after surgery. No recurrence of grade II varic oceles was observed. Only 1 of the 33 patients might have had testicular at rophy, yet he had already fathered 3 children! Twenty-three had a normal sp erm count and 24/27 showed normal sperm motility. Eight hydroceles were eit her present at the time of investigation or had been operated upon in the p ast. Estimations of testicular volume by OM and US showed significant diffe rences between the two methods concerning volume and relation of right to l eft side. In general, the volume was overestimated by the OM. The study sho ws that in boys the simple surgical technique proposed by Palomo has - in t he long run - no disadvantages for testicular development and sperm product ion. Fertility should therefore not be compromised.